Role of frozen section in surgical management of ovarian neoplasm

Palakkan, Saphina; Augestine, Tony; Valsan, MK; Vahab, K P Abdul; Nair, Lekha K

doi:10.4103/gmit.gmit_2_19

Cited by 13 publications

(4 citation statements)

References 17 publications

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“…The accuracy of FS can be affected by various factors, including sampling error, quality of the frozen section, and experience of pathologists. 27,28 Most previous studies concluded that misdiagnosis was more common in mucinous tumors due to the large size and high heterogeneity, while it has also been suggested that tumor size does not correlate with the incorrect diagnosis of frozen pathology. [29][30][31][32] The present study found that tumor size was an independent risk factor for misdiagnosis, either over-diagnosis or under-diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting the Diagnostic Discordance Between Frozen and Permanent Sections in Mucinous Ovarian Tumors

Shao,

Wang,

Liu

2024

IJWH

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Purpose To investigate the accuracy of intraoperative frozen section (FS) diagnosis for predicting the permanent section (PS) diagnosis of mucinous ovarian tumors and evaluate the factors affecting the diagnostic discordance. Patients and Methods This retrospective cohort study was performed in Tianjin Medical University General Hospital. All women who underwent ovarian surgery with FS between January 2011 and December 2022 were identified, and those with a diagnosis of mucinous ovarian tumor (MOT) by FS or PS were reviewed. Clinical and pathologic data were extracted. Results A total of 180 women were included, of which 141 (78.33%) had diagnostic concordance between FS and PS, yielding a sensitivity of 83.43% and a positive predictive value (PPV) of 92.76%. Under- and over-diagnosis occurred in 28 cases (15.56%) and 11 cases (6.11%). Tumor size > 13cm (OR 3.79, 95% CI 1.12–12.73) was an independent risk factor for under-diagnosis, and tumor size ≤ 13cm (OR 16.78, 95% CI 0.01–0.49), laparoscopic surgery (OR 0.14, 95% CI 0.02–0.92), the combination of other tumor components (including serous, Brenner tumor, and chocolate cyst; OR 7.00, 95% CI 1.19–41.12) were independently associated with over-diagnosis. The Kaplan-Meier survival curves and the Log rank test showed no significant difference between misdiagnosed and accurately diagnosed patients (all P > 0.05). Conclusion Intraoperative frozen pathology of MOT is problematic for under- and over-diagnosis. The incorrect diagnosis of FS was related to determining the extent of surgery but had no impact on the patients’ long-term recurrence and survival outcomes. In future clinical practice, surgeons need to obtain material accurately and enhance communication with pathologists during the operation to improve the accuracy of FS diagnosis.

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Section: Discussionmentioning

confidence: 99%

Factors Affecting the Diagnostic Discordance Between Frozen and Permanent Sections in Mucinous Ovarian Tumors

Shao,

Wang,

Liu

2024

IJWH

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“…Laparoscopy is a good addition to computed tomography (CT), and the combination of CT and laparoscopy may be a better preoperative assessment for patients with epithelial ovarian cancer before planning primary cytoreduction and estimating resectability and hence prognosis. [ 19 20 21 ]…”

Section: Discussionmentioning

confidence: 99%

Surgical Site Infection in Laparoscopic Hysterectomy Versus Abdominal Hysterectomy in Gynecological Disease(s): An Overview

Agarwal,

Sinha*,

Haripriya

et al. 2023

Gynecology and Minimally Invasive Therapy

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Objective: Surgical site infection (SSI) is an unsettled complication seen in any surgery. The aim of this study is to assess the rate of postoperative SSIs between total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH). Can the rate of SSI be reduced with the use of a laparoscopic mode of hysterectomy over abdominal? Materials and Methods: It was a retrospective comparative study. The study was conducted in the obstetrics and gynecology department at a tertiary care center from June 2016 to March 2020. A total of 300 patients who underwent hysterectomy either via laparoscopic or abdominal route were included in the study. They were subdivided into two groups: a total of 167 underwent TLH (Group 1) and 133 had TAH (Group 2). The results were compared. It included the age and body mass index of the patient, indication of surgery, size of the uterus, intraoperative blood loss, postoperative SSIs, duration of hospital stay, and readmission rates. Results: It was found a high rate of SSI in TAH (82.4% vs. 17.6%, P < 0.001, Cramer’s V-0.18), the operative time taken (75 ± 25 min vs. 128 ± 52 min, P < 0.001), and the mean blood loss during TLH (110 ± 30 ml vs. 160 ± 116 ml, P < 0.001) was found significant for patients. The hospital stay after TLH was found to be significantly shorter (4 ± 2.47 days vs. 7 ± 2.43, P < 0.001). Conclusion: TLH has improved the psychological, physical, and financial burden on the health care department. Thus, it has proved a preferred route over TAH.

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“…Even though in our small series the initial diagnosis of PCa with frozen sections was confirmed in all cases, one case revealed an upgrade in the Gleason score. Therefore, more robust evidence is awaited to confirm reliability and diagnostic accuracy of frozen sections for PCa, similarly to several oncological contexts, such as ovarian cancer [ 31 ] and endometrium [ 32 ]. This lays the foundations of a possible fusion of the diagnostic and therapeutic moment in those patients who are candidates for focal therapy with an expected reduction in costs, patients’ distress and the waiting list.…”

Section: Discussionmentioning

confidence: 99%

Single-Setting 3D MRI/US-Guided Frozen Sectioning and Cryoablation of the Index Lesion: Mid-Term Oncologic and Functional Outcomes from a Pilot Study

Misuraca

Lugnani²,

Brassetti

et al. 2023

JPM

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Our study explored frozen section reliability in prostate cancer (PCa) diagnoses and described surgical steps of a 3D magnetic resonance imaging (MRI)–ultrasound (US)-guided prostate biopsy (PB) and focal cryoablation of the index lesion (IL) in a single-setting procedure. Patients with a suspicious prostatic specific antigen (PSA) value, with a PIRADS 4 or 5 single lesion, were enrolled for trans perineal 3D MRI–US-guided PB and TRUS-guided focal cryoablation. Three cores were taken from the IL, three cores from the surrounding area, while systematic sampling was performed for the rest of the gland. After confirmation of PCa in frozen sections, focal cryoablation was performed. The 1st-year follow-up schedule included a PSA test at a 3-month interval, MRI 3 months and 1 year postoperatively and PB of the treated area at 1 year. Following the follow-up schedule, an involved PSA test at a 3-month interval and yearly MRI were performed. The PCa diagnosis was histologically confirmed in all three patients with frozen sections. At final histology, a single Gleason score upgrade from 6 (3 + 3) to 7 (3 + 4) was observed. All patients were discharged on postoperative day 1. At the 3-month evaluation, mean PSA values decreased from 12.54 (baseline) to 1.73 ng/mL and MRI images showed complete ablation of the IL in all patients. Urinary continence and potency were preserved in all patients. At the 1-year follow-up, one patient had suspicious ipsilateral recurrence on MRI and underwent a new analogous procedure. Post follow-up was uneventful and PSA remained stable in all patients. Three-dimensional MRI–US-guided frozen sectioning and focal cryoablation of the IL is a step forward towards a “patient-tailored” minimally invasive approach to the diagnosis and cure of PCa.

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Role of frozen section in surgical management of ovarian neoplasm

Cited by 13 publications

References 17 publications

Factors Affecting the Diagnostic Discordance Between Frozen and Permanent Sections in Mucinous Ovarian Tumors

Factors Affecting the Diagnostic Discordance Between Frozen and Permanent Sections in Mucinous Ovarian Tumors

Surgical Site Infection in Laparoscopic Hysterectomy Versus Abdominal Hysterectomy in Gynecological Disease(s): An Overview

Single-Setting 3D MRI/US-Guided Frozen Sectioning and Cryoablation of the Index Lesion: Mid-Term Oncologic and Functional Outcomes from a Pilot Study

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